Three Exercises for Shin Splints (MTSS)

Medial Tibial Stress Syndrome

Medial Tibial Stress Syndrome (MTSS) is a common injury suffered by runners and triathletes. Known to most athletes as ‘shin splints’, MTSS refers to pain along the medial (inside) aspect of the tibia. It is typically either an inflammation of the lining of the bone or tendinopathy of the muscles inserting into the medial tibia (tibialis posterior, soleus and flexor digitorum longus). While MTSS is very common and plagues numerous athletes, it is also often easily prevented.

As with many overuse injuries, MTSS results from the inability of muscles and tendons to continually support repetitive forces which may break down over time and/or transfer load to the bone. Triathletes are particularly susceptible to the condition since both running and cycling are highly repetitive. The same forces are being applied to the same tissue over and over, making a preventative approach especially important for these athletes.

MTSS is diagnosed when there is tenderness or an ache continuing several centimetres along the inside of the calf or shin bone that is worse following running. A smaller area of sharp or acute pain on the bone may indicate a local stress reaction or even a stress fracture. As always, athletes are best to seek advice from an experienced therapist for an accurate diagnosis and also help facilitating a safe return to training as soon as possible.

Over the years of treating runners and triathletes, I have noticed a number of factors that appear to contribute to the development of MTSS:

Quick changes in volume and or intensity of running

Tight, weak and/or overactive calf muscles

Running on hard surfaces, which increases maximum peak forces

Excessive pronation (flat feet)

Poor running technique; particularly over striding/low cadence form or a pronounced forefoot or toe running technique, which can include poor technique on hills

Off camber surfaces

Poor or inappropriate footwear

Running when fatigued – thus reducing the muscle’s ability to absorb force, making any injury more likely

Treatment & Prevention of MTSS

A few basic rules to follow are:

Increase mileage slowly and consistently, no quick changes!

Avoid running on hard surfaces where at all possible – grass, trail and other softer surfaces greatly reduce impact forces of the lower limb

Improve your run technique, especially:

Increase your cadence

Reduce any tension you carry in your feet – many people carry tension in the area unconsciously

Allow your feet to engage with the ground to use your natural shock absorber, which is the arch of your foot and plantar fascia

Massage or self-massage areas of muscular tightness but not where bone is painful

Bike riders, make sure cleat position is suitable on bike, as this can add to loading

During runs, take thirty seconds every five to ten minutes for a brief period of walking followed by some calf dynamic stretches. This helps to reduce tension and maintain run form, especially when you are getting tired!

Most importantly, remember that MTSS is something that you don’t have to put up with. By taking a consistent and proactive approach you will be able to do away with the dreaded shin splints once and for all!

Alex is a physiotherapist and triathlon coach based in Wollongong NSW. After ten years of coaching experience Alex founded the AP10 coaching group in 2010 and which is now very strong, including professional, elite and age-group athletes from around Australasia.

Alex’s work as a triathlon physiotherapist includes his role with the AIS and NSWIS triathlon teams, whom he accompanies to Europe each year, and which also included athletes during their preparation for the London Olympic Games.

He has also worked on the Tour de France and at the Athens Olympics. Alex studied the gold standard F.I.S.T. Slowtwitch bike fitting course in California.

A successful triathlete in his own right, Alex has raced for many years and placed third in his age group at the 2012 World Long Course championships in Spain.

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10 Comments

Could you please tell us how often to do these exercise? i.e. how many times a week? how many sets? how many reps?

And also, the quality of the audio is not very good and I couldn’t understand the instructions at the end regarding the calf raises. Should we let our ankles bend like at the beginning or keep them straight like in the end?

I think my problem may have gone past the shin splint stage and progressed to a stress response or even fracture. I feel pain when i press a particular spot on the inner aspect of lower tibia. I had an X-ray done about a month ago. Tibia/fibula normal. I have seen a physio who set me up with hip and ankle strengthening exs, as i have perennially weaker left hip. In addition to that i have flat feet, so working on strengthening my invertors as well. I have also been doing aqua jogging 2-3 times per week. Why do I still have the pain? What am i doing wrong? It has been two months since I last ran. My physio told me to minimise time on feet but that is quite difficult given my job in the community. Any advice greatly appreciated!